Injury Clinic

Knee Pain / Arthroscopy: Brandy Hildebrand

Brandy Hildebrand is a busy mom. With three children at home, Hildebrand also is pursuing a degree in secondary education with an emphasis on chemistry from Southern Illinois University.

Two years ago, Hildebrand, 36, started experiencing pain in her right knee. At first, she tried to ignore the pain, taking over-the-counter pain medications when needed. “I just had a lot going on in my life, so I just tried to deal with it,” Hildebrand says. “But the pain got worse over time.”

Hildebrand was referred to sports medicine specialist Robert Brophy, MD, an orthopedic surgeon at Washington University/Barnes-Jewish Hospital who specializes in both knee and shoulder problems. Brophy first used a conservative approach to alleviating the pain.

“There are many options we can offer patients that don’t involve surgery,” Brophy explains. “These range from prescription medications to various injections that can minimize or eliminate the pain.”

Hildebrand was first given a cortisone injection. Next she received a hyaluronic acid injection, sometimes called by its brand name, a Synvisc® injection. “Hyaluronic acid is a natural part of the fluid that is found in the joints,” says Brophy. “Through an injection of hyaluronic acid, we can lubricate the joint and reduce inflammation to provide pain relief for as long as six months.”

Joint fluid sometimes breaks down due to osteoarthritis or injury. Injections of hyaluronic acid can decrease inflammation and reduce pain, but they have one drawback — a delayed effect. “It can take from four to six weeks for patients to benefit from a hyaluronic acid injection,” he says. “The majority of patients will benefit within several weeks. If there’s no change in pain or discomfort by four to six weeks, the injection is probably not going to help over the long term.”

When the pain kept returning, Hildebrand opted for arthroscopy, a minimally invasive outpatient procedure that allows surgeons to get a close up view of the joint and repair minor tears. “She did have a tear in her meniscus and noticeable wear and tear on her cartilage, which we cleaned up,” Brophy notes. “She does have pre-arthritis, which will be an ongoing concern to monitor.”

Hildebrand benefits from clinical research under way at Washington University School of Medicine and six other medical centers that is focused on evaluating the use of arthroscopy versus physical therapy for the treatment of meniscus tears that are accompanied by osteoarthritis in the knee. Called the Meniscal Tear with Osteoarthritis Research (MeTeOR) study, the multicenter research project is focused on determining which patients do better with non-operative options. The study is significant because arthroscopy can be highly effective for treating meniscal tears. When advanced osteoarthritis is present, however, the effect dramatically diminishes. Early results have found that physical therapy may be just as effective as arthroscopy, but the key will be identifying when that benefit is reduced as osteoarthritis progresses.

For now, Hildebrand’s knee is better, although she remains under the care of Dr. Brophy after a fall last year re-injured her knee. “I love Dr. Brophy,” Hildebrand says. “He’s trying to do everything he can to keep me pain-free.”